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Efforts to advertise safer opioid prescribing in Canada look like having an impact, as new analysis within the Canadian Medical Affiliation Journal reveals a lower in opioid shelling out between 2018 and 2022.
Within the early 2000s, use of prescription opioids to deal with acute and persistent noncancer ache elevated considerably in Canada, and with it got here an increase in opioid-related harms. The provision of extra opioid merchandise, coupled with aggressive advertising of those medicine, contributed to those early will increase in Canada and in different nations.
Many initiatives have been launched with the objective of decreasing these harms all through the nation, together with coverage adjustments, a deal with persevering with medical schooling for evidence-based prescribing, and a nationwide Canadian guideline for opioid prescribing printed in 2017.
With these adjustments, a necessity has emerged for nationwide data on prescription opioid use in Canada and the way this varies in numerous components of the inhabitants. Researchers aimed to assist fill this hole with a research of opioid prescribing in six Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and Quebec) between 2018 and 2022.
The variety of folks newly beginning opioids declined 8% through the research interval, and the overall variety of folks accessing opioids declined 11%. In 2022, throughout Canada, roughly 1.8 million folks began an opioid to handle ache for the primary time. Nevertheless, the speed of opioid prescribing different amongst provinces, starting from 55 new opioid begins per 1000 folks in Ontario to 63 per 1000 folks in Alberta.
“[T]he interprovincial variations in our findings may indicate differences in the implementation of prescribing guidelines, underscoring the need for coordinated national strategies and ongoing evaluation of their effects on patient outcomes,” writes Dr. Tara Gomes, a researcher within the Ontario Drug Coverage Analysis Community at St. Michael’s Hospital, Unity Well being Toronto, with co-authors.
Annual charges of recent prescriptions had been greater for females, older adults, and other people residing in lower-income neighborhoods and rural areas. Codeine was most often prescribed in most provinces, except for Quebec, the place folks had been extra generally allotted morphine and hydromorphone.
Oxycodone shelling out decreased over time, though in Ontario over one-quarter of opioids prescribed had been nonetheless for oxycodone in 2022.
The authors warning that though decrease charges of opioid prescribing might mirror medical doctors’ efforts to make sure secure and applicable prescribing, a stability is required to make sure that persons are not left with out ache reduction or lower off from medicines with out applicable helps and coordination of care.
“Importantly, although these recommendations are intended to promote safer opioid prescribing, improper implementation can lead to rapid dose tapering, abrupt opioid discontinuation, and reluctance to initiate patients on opioids when clinically indicated. In some cases, these changes have led to patients seeking access to opioids from the unregulated drug supply, which are inherently more harmful,” write the authors.
The researchers counsel that clinicians interact in conversations with sufferers to make sure shared decision-making, and assess ache ranges and skill to operate.
“The truth is … that opioids are less effective and less safe than many care to admit,” writes Dr. David Juurlink, an internist and researcher at Sunnybrook Analysis Institute and the College of Toronto, Toronto, Ontario, in a associated commentary praising the continued decline in opioid prescribing.
Opioids might be efficient when fastidiously prescribed, notably for brief durations. However, with long-term use, their effectiveness can wane and so they can hurt sufferers in methods which might be exhausting to understand.
“Most clinicians have seen how well opioids can work when first given,” writes Dr. Juurlink. “But they are at their pharmacologic best in the initial days of treatment. Continue them for weeks, months, or years and the calculus becomes progressively less favorable.”
Juurlink urges considerate prescribing, which “begins with recognizing that all patients in pain fall into one of three mutually exclusive groups: those not yet on opioids, those taking opioids chronically (sometimes called ‘legacy patients’), and those with established addiction. The latter two groups overlap and are easily harmed by rapid dose reduction, but they can also be harmed by dose escalation. For such patients, when pain intensifies, nonopioid strategies are preferred. The first group, by contrast, has the most to gain from thoughtful opioid stewardship.”
Extra data:
Tendencies in prescription opioid use for ache in Canada: a population-based repeated cross-sectional research of 6 provinces, Canadian Medical Affiliation Journal (2025). DOI: 10.1503/cmaj.250670
Canadian Medical Affiliation Journal (2025) www.cmaj.ca/lookup/doi/10.1503/cmaj.251666
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Canadian Medical Affiliation Journal
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Efforts to advertise safer opioid prescribing in Canada look like having an impact (2025, October 27)
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